Your Standard of Practice for Maternity MVC Patients

1. Hi, everyone! I have a clinical question and wanted peoples' opinions since every facility is different. When you have a greater than 20 week pregnant female who was involved in a minor or major MVC, what is your facility's standard of practice for patient care?
   
   For instance, at our facility, we clear the patient medically before sending them to L+D. What does your facility do?
   
   Thanks for your input! Jeanne
2. 

   About jeannet83

   Joined: Mar '03; Posts: 87; Likes: 4
   emergency room RN

   10 Comments

   Topic Closed
3. 
   Mar 30, '03

   Straight to the labor unit unless they have obvious traumatic injury that needs to be handled in the ER. If that is the case we send an OB nurse down with a moniter.
4. 
   Mar 30, '03

   All trauma patients, no matter how far along in their pregnancy, get an ED evaluation first. Biggest cause of fetal mortality after trauma is maternal mortality. OB may miss subtle signs of injury that could lead to problems.
   
   Once a complete ED evaluation is done, then they go to OB for at least 6 hours of TOCO/FHR monitoring.
   
   See the following articles for good info/guidelines:
   
   "Pregnancy outcome and fetomaternal hemorrhage after non-catastrophic trauma" American Journal of Obstetrics and Gynecology 1990;162:665-671
   
   "Evaluation and treatment of the gravida and fetus following trauma during pregnancy" Obstetric and Gynecologic Clinics of North America 1991;18:371-381
   
   Summary of articles is below:
   
   Perform trauma assessment and treatment as usual with the following additions:
   Assess FHR early
   Tocodynamic monitoring ASAP and for 6 hours after trauma
   Need continuous monitoring to better evaluate for decelerations and beat to beat variability
   Patients admitted for other reasons should be monitored throughout their hospitalization
   
   Patients with significant risk factors
   
   MHR > 110
   ISS > 9
   Absent FHT
   FHR < 120 or > 160
   Ejection
   MCC
   Pedestrian collision
   
   ALL get monitored for at least 24 hours
   
   Others
   Monitor for 6 hours
   If no evidence of frequent contractions or FHR changes may be discharged
   3rd trimester status without other risk factors is not an indication for prolonged (24 hour) monitoring
5. 
   Mar 30, '03

   We do not have OB at our facility...we do an ED eval and transport them to the closest L&D hospital for further observation.
6. 
   Apr 1, '03

   < 20 weeks, to the er... > 20 weeks, straight to ob
7. 
   Apr 1, '03

   Originally posted by erdiane
   < 20 weeks, to the er... > 20 weeks, straight to ob

   What if your patient has head or chest trauma? Still straight to OB?? Original question was for minor or major trauma.

   Last edit by RNCENCCRNNREMTP on Apr 3, '03
8. 
   Apr 3, '03

   The reason I was asking the initial question is that we are in the process of revamping our standards of practice for pregnant females in the ED.
   
   For really basic, low impact MVC >20 weeks who has not sustained major trauma, we are now planning on having OB/GYN set up at least continuous FHR monitoring while being evaluated in ED (obviously same for pregnant major traumas). (Even though as stated earlier that major indication for fetal death is major maternal injury). Previously for low impact MVC's, we would do spot check FHR.
   
   For those of you who evaluate >20 weeks pregnant females in ED first before sending to L+D, do you do continuous FHR monitoring and/or tochometer (am I spelling that right? ie., contraction monitor).
   
   Just curious what other places are doing for their Standards of Practice. Thanks! Jeanne
9. 
   Apr 3, '03

   we send them to OB if they are over 20 weeks, unless there is an obvious trauma issue happening. if so, OB nurse comes to er with a monitor.
10. 
    Oct 3, '03

    All trauma pts seen in ED first, After cleared of other needs, to OB if over 20 weeks.
11. 
    Oct 7, '03

    under 20 weeks to the ER and over 20 weeks are cleared medically first, then to L&D.
12. 
    Oct 7, '03

    We ususally do FHT spot checks too, but can call L&D for monitor in ER and L&D nurse does the monitoring and charting for this.

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